Lower extremity peripherally inserted central catheter placement ectopic to the ascending lumbar vein:A case report

BACKGROUND Peripherally inserted central catheters(PICCs)are an essential infusion route for oncology patients receiving intravenous treatments,but lower extremity veni-puncture is the preferred technique for patients with superior vena cava syndrome(SVCS).We report the case of a patient with a lower extremity PICC ectopic to the ascending lumbar vein,to indicate and verify PICC catheterisation in the lower extremity is safe and feasible.And hope to provide different per-spectives for clinical PICC venipuncture to get the attention of peers.CASE SUMMARY On 24 August 2022,a 58-year-old male was admitted to our department due to an intermittent cough persisting for over a month,which worsened 10 d prior.Imaging and laboratory investigations suggested the patient with pulmonary malignancy and SVCS.Chemotherapy was not an absolute contraindication in this patient.Lower extremity venipuncture is the preferred technique because administering upper extremity venous transfusion to patients with SVCS can exacerbate oedema in the head,neck,and upper extremities.The patient and his family were informed about the procedure,and informed consent was obtained.After successful puncture and prompt treatment,the patient was discharged,experiencing some relief from symptoms.CONCLUSION Inferior vena cava catheterisation is rare and important for cancer patients with SVCS,particularly in complex situations involving ectopic placement.

Clues for diagnosing misplaced central venous catheter in the right ascending lumbar vein during right femoral venous access

The right ascending lumbar vein is difficult to detect on anteroposterior abdominalradiographs because it overlaps with the inferior vena cava on anteroposteriorradiographs.Intensive observation by medical providers may be a cue fordiagnosis.However,knowledge of catheter misplacement of the right ascendinglumbar vein is also necessary,because misplacement cannot be suspected withoutthat awareness.

Clinical effect of preventive nursing on the rate of deep vein thrombosis in patients with lung cancer: A meta-analysis

Objective:To explore the clinical effect of preventive nursing intervention on deep venous thrombosis rate,nursing satisfaction and average hospitalization time after treatment of lung cancer.Methods:Chinese databases(Wanfang,Weipu and China Knowledge Network)and English databases(Pubmed,Cochrane and Scopus)were searched and read references for relevant research.Statistical analysis was performed using Review Manager 5.3.The odds ratio(OR)and the mean difference(MD)were used as the combined effect values of the comparison groups.Sensitivity analysis was performed by changing the effect model or excluding the literature with a large weight ratio,and the symmetry of the funnel plot was observed for publication bias test.Results:A total of 14 Chinese studies included.Compared with routine nursing intervention,preventive nursing intervention could significantly reduce the rate of deep vein thrombosis after lung cancer treatment[OR=0.16(0.10,0.23)],improve nursing satisfaction[OR=6.42(3.32,12.41)]and shorten the average hospital stay[MD=-7.41(-8.16,-6.65)],without heterogeneous existing.And regardless of whether the lung cancer patient was undergoing resection or chemotherapy,the effect of preventive nursing intervention to reduce the rate of deep vein thrombosis was very significant.Conclusion:Preventive nursing intervention is beneficial to patients with lung cancer,which can significantly reduce the formation rate of deep vein thrombosis,which is worthy of clinical promotion.

Prevention of central venous catheter-related infection in ICU with cluster nursing intervention: a meta-analysis

Objective:To systematically evaluate the clinical effects of cluster nursing intervention in preventing central venous catheter-related infection in intensive care unit.Methods:A randomized controlled study was searched from China National Knowledge Internet(CNKI),Wanfang,Chinese Scientific Journals Database(VIP),Chinese Biomedical Literature Service System(SinoMed),PubMed,Embase and Cochrane library databases from the establishment to May 1,2020.Two reviewers independently evaluated and cross checked the quality of the study.Revman 5.3 was used to conduct the meta-analysis.Results:A total of 21 randomized controlled trials with 6,030 patients were included.Meta-analysis showed that the incidence of central venous catheter-related infection(relative risk(RR)=0.29,95%confidence interval(CI)[0.23,0.37]),the incidence of catheter plugging(RR=0.25,95%CI[0.16,0.39])and catheter prolapse(RR=0.18,95%CI[0.11,0.29])were significantly different between the two groups.Conclusion:Cluster nursing intervention could prevent central venous catheter-related infection in intensive care unit.

Nursing Care of Patients With Transcatheter Closure of Atrial Septal Defect via Femoral Vein

Objective:To explore the operative nursing coordination method for the treatment of congenital atrial septal defect(ASD)by transcatheter closure of atrial septal defect via femoral vein.It provides useful experience for the treatment of congenital heart disease.Methods a total of 12 patients undergoing minimally invasive atrial septal defect closure via femoral vein from January 2017 to November 2017 in our department of cardiac surgery were selected as the subjects.All patients received transesophageal ultrasound guided ASD occlusion by femoral vein.The operation and nursing contents include preoperative care,the cooperation of the itinerant nurses,the coordination of the instrument nurses and the postoperative nursing.Results the operation of 12 patients in this group was successful.The diameter of the occluder was 17.1+4.5 mm during the operation.The time of tracheal intubation was 2.4+0.7 h,from the femoral vein to the sheath tube time was 38.7+9.4 min,the occupancy of ICU was 12.5+2.6 h after the operation.The average time of hospitalization was 4.5+1.8 D.There were 2 cases of shunt 1mm immediately after operation.After 24h reexamination,the shunt disappeared,the heart murmur disappeared in the rest of the patients.No residual shunt and other complications occurred.

Microvascular changes after conbercept therapy in central retinal vein occlusion analyzed by optical coherence tomography angiography

AIM: To investigate microvascular changes in eyes with central retinal vein occlusion(CRVO) complicated by macular edema before and after intravitreal conbercept injection and evaluate correlations between these changes and best-corrected visual acuity(BCVA) and retinal thickness. METHODS: Twenty-eight eyes of 28 patients with macular edema caused by CRVO were included in this retrospective study. All patients received a single intravitreal conbercept injection to treat macular edema. BCVA and the results of optical coherence tomography angiography(OCTA) automatic measurements of the vessel density in the superficial(SCP) and deep retinal capillary plexus(DCP), the foveal avascular zone(FAZ) area, the FAZ perimeter(PERIM), the vessel density within a 300-μm wide ring surrounding the FAZ(FD-300), the acircularity index(AI), the choriocapillaris flow area, and retinal thickness were recorded before and at one month after treatment and compared with the results observed in age-and sexmatched healthy subjects. RESULTS: The vessel density in the SCP and DCP, the FD-300, and the flow area of the choriocapillaris were allsignificantly lower in CRVO eyes than in healthy eyes, while the AI and retinal thickness were significantly higher(all P<0.05). After treatment, retinal thickness was significantly decreased, and the mean BCVA had markedly improved from 20/167 to 20/65(P=0.0092). The flow area of the choriocapillaris was also significantly improved, which may result from the reduction of shadowing effect caused by the attenuation of macular edema. However, there were no significant changes in SCP and DCP vessel density after treatment. The flow area of the choriocapillaris at baseline was negatively correlated with retinal thickness.CONCLUSION: OCTA enables the non-invasive, layerspecific and quantitative assessment of microvascular changes both before and after treatment, and can therefore be used as a valuable imaging tool for the evaluation of the follow-up in CRVO patients.

Intravitreal injection of bevacizumab alone or with triamcinolone acetonide for treatment of macular edema caused by central retinal vein occlusion

AIM: To compare the efficacy and safety of intravitreal bevacizumab alone versus bevacizumab combined with triamcinolone acetonide in eyes with macular edema caused by central retinal vein occlusion (CRVO) in Chinese patients. METHODS: Seventy-five eyes of 75 patients were enrolled in this prospective, randomized, consecutive study. Thirty-six patients in group 1 were treated with an intravitreal injection of bevacizumab (1.25mg/0.05mL), and 39 patients in group 2 were treated with intravitreal bevacizumab (1.25mg/0.05mL) combined with triamcinolone acetonide (2mg/0.05mL). The main outcomes of the mean best corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP) were measured. RESULTS: In group 1, the mean BCVA improved from 37.78 +/- 6.14 (baseline) to 48.06 +/- 3.86, 46.48 +/- 4.77 and 44.18 +/- 5.78 at four, six and twelve weeks post-injection, respectively (P<0.01, P=0.03, P=0.04). In group 2, the mean BCVA improved from 35.92 +/- 6.20 (baseline) to 50.69 +/- 4.22, 48.76 +/- 5.59 and 45.70 +/- 6.56 at the same time points (P<0.01 each). However, there was no significant differences in the mean BCVA (F=0.043, P=0.836) and CRT (F=0.374, P=0.544) between these two groups. During the follow-up, five patients in group 1 and six patients in group 2 with high IOP were controlled with anti-glaucoma drugs. CONCLUSION: Intravitreal injection of bevacizumab alone or combined with triamcinolone acetonide has a short beneficial effect in Chinese patients with macular edema caused by CRVO, but there is no significant difference between the two groups.

Predictors of short-term outcomes related to central subfield foveal thickness after intravitreal bevacizumab for macular edema due to central retinal vein occlusion

AIM：To investigate the predictive factors for shortterm effects of intravitreal bevacizumab injections on central subfield foveal thickness（CSFT）in patients with macular edema（ME）secondary to central retinal vein occlusion（CRVO）.·METHODS：This was a retrospective study in 60 eyes treated with intravitreal bevacizumab injections for ME due to CRVO.Follow-up was three months.The Early Treatment Diabetic Retinopathy Study（ETDRS）score and CSFT measured by spectral-domain optical coherence tomography（SD-OCT）were used to observe the changes in best-corrected visual acuity（BCVA）.Baseline BCVA,CSFT,age,CRVO duration and the presence of cystoid macular edema（CME）or subretinal fluid（SRF）were analyzed as potential predictive factors of the effects of intravitreal bevacizumab injections.·R ESULTS：BCVA improved from 0.9 log MAR at baseline to 0.6 log MAR at 3mo,which was associated with a significant reduction in CSFT from 721μm to 392μm 3mo after injection.About 50%of CME cases and more than90%of SRF cases responded to treatment with a complete resolution at 3mo.Age（=0.036）and low baseline CSFT（=0.037）were associated with a good 3-month prognosis.Patients〉60 years old achieved better CME resolution（=0.031）and lower CSFT at 3mo（305μm 474μm,=0.003）.·CONCLUSION：Intravitreal bevacizumab significantly improved visual acuity and CSFT in patients with CRVO after 3mo.Older age and lower baseline CSFT were good predictors of short-term CSFT outcomes.The retinal thickness response to bevacizumab might depend on the resolution of CME rather than SRF.

Ocular hypertension in patients with central/hemicentral retinal vein occlusions： cumulative prevalence and management

AIM： To prospectively evaluate the cumulative prevalence and the management of ocular hypertension（OH） in patients with unilateral acute central/hemicentral retinal vein occlusions（C/HCRVOs） over the course of 3 y. METHODS： The study included 57 patients with unilateral acute C/HCRVOs. All patients underwent a comprehensive ophthalmological examination of both eyes. OH associated with C/HCRVO in patients showing a score 〉5% for the risk of conversion to primary open angle glaucoma（POAG） was treated with OH medication. The treatment aimed for a decrease in intraocular pressure（IOP） to 〈21 mm Hg with a 〉22% reduction from the initial values. The cumulative prevalence of OH and the effectiveness of treatment assessed by the cumulative prevalence of conversion from OH to POAG, were estimated. RESULTS： Fifteen patients had OH associated with C/HCRVOs, the cumulative prevalence of OH was 29.4%（95% confidence interval, 16.9-41.9）. The mean value of the risk score of OH conversion to POAG for the 5 subsequent years was 11.7%±5.4%. The IOP significantly decreased from 25.67±2.16 mm Hg to 18.73±2.96 mm Hg. None of the OH patients converted to POAG during the follow-up period. CONCLUSION： The increased cumulative prevalence of OH in C/HCRVO patients indicates that OH is a risk factor for the appearance of venous occlusion. Patients with OH associated with C/HCRVO must be considered to be at high risk for conversion to POAG. Treatment with OH medications prevented conversion to POAG during the 3-year follow-up.

Efficacy of conbercept after switching from bevacizumab/ranibizumab in eyes of macular edema secondary to central retinal vein occlusion

AIM: To explore the efficacy of conbercept after switching from bevacizumab/ranibizumab in eyes of central retinal vein occlusion(CRVO) through optical coherence tomography angiography(OCTA). METHODS: Patients with prior treatment of a minimum of three consecutive intravitreal injections of either bevacizumab or ranibizumab, followed by injection of conbercept, were recruited. The minimal follow-up period after switching was 12 mo. Central retinal thickness(CRT), best-corrected visual acuity(BCVA), the interval of injections was reviewed. Perfusion density(PD) and vascular length density(VLD) of superficial and deep capillary plexus were acquired from OCTA images before and after switching. RESULTS: Twenty-four eyes were included. CRT significantly decreased from 460.71±153.23 μm(before switching) to 283.92±38.27 μm at the end of follow-up(P<0.001). However, BCVA gained to some extent(from 0.98±0.33 to 0.76±0.42 log MAR) but the difference was not significant(P=0.070). After switching to conbercept the injection interval extended from 5.2±2.3 wk to 8.3±3.9 wk(P=0.012). At the end of follow-up, PD of deep retinal layer decreased significantly compared with before switching(from 34.62%±5.27% to 33.26%±5.82%, P=0.016), similar result was found in VLD of deep retinal layer but not in PD or VLD in superficial layer.CONCLUSION: In cases of refractory macular edema secondary to CRVO, switching to conbercept improves macular thickness and extends interval of injection. Retinal microvasculature cannot improve with treatment of conbercept.

Correlation between obstructive sleep apnea and central retinal vein occlusion

To investigate the possible correlation between obstructive sleep apnea(OSA) and central retinal vein occlusion(CRVO). Thirty consecutive patients with a recent(<3 mo)CRVO and an age-and sex-matched group of 30 control subjects were recruited. All subjects underwent full-night polysomnography to measure apnea-hypopnea index(AHI)and oxygen desaturation index(ODI). The average AHI and ODI were significantly higher in CRVO patients(AHI:13.86±8.63, ODI: 9.21±4.47) than in control subjects(AHI:8.51±6.36, ODI: 5.87±3.18;P=0.008 and 0.001 respectively).Additionally, the AHI was positively correlated with body mass index(BMI;r=0.476, P=0.017) and ODI(r=0.921,P<0.01) in both CRVO and control subjects. According to AHI scores, twenty-two(73.33%) CRVO patients had OSA and 12(40.00%) control subjects had OSA, a difference that was statistically significant(P=0.019). OSA may be a risk factor for or a trigger of CRVO development.

Long-term outcomes of anti-VEGF treatment with 5+PRN regimen for macular edema due to central retinal vein occlusion

AIM:To assess the long-term outcomes of treating macular edema(ME)associated with central retinal vein occlusion(CRVO)with a regimen of“5+pro re nata(PRN)”.METHODS:This retrospective study included 27 eyes of 27 patients with ME associated with non-ischemic CRVO(non-iCRVO group,n=15)and ischemic CRVO(iCRVO group,n=12).The eyes were treated with five consecutive intravitreal injections of conbercept or ranibizumab,followed by reinjections as needed or PRN.Retinal laser photocoagulation or intravitreal dexamethasone implants(DEX)were implemented in both groups when necessary.The best-corrected visual acuity(BCVA,logMAR)and central retinal thickness(CRT)were recorded at baseline,at 1,2,3,4,5,6,and 12mo,and at the final visit.The efficacy rates of BCVA and CRT before and after treatment were calculated.The number of injections at each visit and the incidence of adverse events were also recorded.RESULTS:The patients,aged 59.4±15.1y,were followed up for 24.7±8.8mo(range:15-42mo).After treatment,BCVA improved significantly from 1.04±0.56 logMAR at baseline to 0.59±0.36 logMAR(P=0.038)at the final visit in all patients.Both the non-iCRVO and the iCRVO groups achieved improved BCVA compared to the baseline at all visit points,but there was no statistical significance(P=0.197 and 0.33,respectively).The mean CRT was statistically reduced compared to baseline at all visit points in all the eyes and in both groups(all P<0.001).The apparent effective rate was 22.22% for BCVA and 37.04% for CRT after the first injection,48.15%for BCVA and 62.96% for CRT after 5 consecutive injections,and 74.08% for BCVA and 100% for CRT at the end of follow up.The average number of injections in all patients was 9.0±2.4 at 12mo and 14.9±8.1 finally with no statistical significance between both groups(P>0.05).Laser treatment was applied to all eyes in the iCRVO group,while only 5 patients in the noniCRVO group.Six patients in the non-iCRVO group and 3 patients in the iCRVO group had a drug switch.DEX was applied to 4 eyes in the non-iCRVO group and 5 eyes in the iCRVO group.CONCLUSION:The 5+PRN anti-vascular endothelial growth factor(VEGF)regimen is found to be safe and effective for both iCRVO and non-iCRVO,especially in the iCRVO group.The best regimen for such patients needs to be further investigated.Adjuvant laser therapy and DEX are necessary in some cases.

Progress of Comprehensive Nursing on the Prevention of Postoperative DVT of Gynecologic Tumor

Deep vein thrombosis (DVT) is the second reason of death due to tumor. In order to find more effective methods for prevention of DVT due to gynecologic tumor, the advances of study and practice in this aspect should be summarized. As an important and effective measure for prevention of DVT, the comprehensive nursing is to be analyzed carefully. Lots of practices show that proper nursing measures can prevent effectively the occurrence of postoperative DVT. Virchow thought that DVT is caused by three factors: injury of venous wall, slowed blood flow and hypercoagulability. Thus, the prevention measures are presented on the factors such as application of sequential decompression elastic socks, intraoperative intervention etc. Clinical nursing pathway is shown to be very effective method recently. More effective measures and related facilities for prevention of DVT should be built in the future. Physical and psychological methods should be combined in the nursing of DVT.

Altered brain network centrality in patients with retinal vein occlusion: a resting-state fMRI study

AIM:To explore the intrinsic brain activity variations in retinal vein occlusion(RVO)subjects by using the voxel-wise degree centrality(DC)technique.METHODS:Twenty-one subjects with RVO and twentyone healthy controls(HCs)were enlisted and underwent the resting-state functional magnetic resonance imaging(rs-f MRI)examination.The spontaneous cerebrum activity variations were inspected using the DC technology.The receiver operating characteristic(ROC)curve was implemented to distinguish the DC values of RVOs from HCs.The relationships between DC signal of definite regions of interest and the clinical characteristics in RVO group were evaluated by Pearson’s correlation analysis.RESULTS:RVOs showed notably higher DC signals in right superior parietal lobule,middle frontal gyrus and left precuneus,but decreased DC signals in left middle temporal gyrus and bilateral anterior cingulated(BAC)when comparing with HCs.The mean DC value of RVOs in the BAC were negatively correlated with the anxiety and depression scale.CONCLUSION:RVO is associated aberrant intrinsic brain activity patterns in several brain areas including painrelated as well as visual-related regions,which might assist to reveal the latent neural mechanisms.

Intraocular pressure modifications in patients with acute central/hemicentral retinal vein occlusions

Intraocular pressure(IOP)modifications in patients with acute central/hemicentral retinal vein occlusions(RVOs)consist in IOP reductions and increases.The IOP reduction is due to a transitional hyposecretory phase of the aqueous humor,that increases gradually until 3 mo after the venous occlusion onset,and then finally disappears after month 4 th.The IOP increases lead to the ocular hypertension and glaucoma.The possible pathogenetic correlations between ocular hypertension/glaucoma and acute central/hemicentral RVOs have been classified into three groups:1)the venous occlusion precedes the ocular hypertension/glaucoma causing neovascular glaucoma and secondary angle-closure glaucoma without rubeosis;2)the ocular hypertension and the glaucoma precede the venous occlusion and favor its appearance(ocular hypertension,primary angle-closure,primary angle-closure glaucoma,and open angle glaucomas);and 3)the venous occlusion and the ocular hypertension/glaucoma are mostly age dependent appearances due to common vascular and collagen alterations,lacking a causal connection between the 2 conditions.

Correlation between macular ganglion cell-inner plexiform layer thickness and visual acuity after resolution of the macular edema secondary to central retinal vein occlusion

AIM： To examine the thickness of the ganglion cell-inner plexiform layer（GCIPL） in eyes with resolved macular edema（ME） in non-ischemic central retinal vein occlusion（CRVO）, applying spectral-domain optical coherence tomography（SD-OCT）, and its relationship with visual acuity.METHODS： The retrospective observational case-control study included 30 eyes of non-ischemic CRVO patients with resolved ME（ME eyes） after treatment, and 30 eyes of non-ischemic CRVO patients without ME（non-ME eyes）. The macular GCIPL thickness, peripapillary retinal nerve fiber layer（p RNFL） thickness and central macular thickness（CMT） were measured on a SD-OCT scan. Linear regression analyses were performed to determine the correlation between the thickness of each and the visual acuity（VA）.RESULTS： No significant difference in average GCIPL thickness, mean pR NFL thickness and CMT were observed between ME group and non-ME group（P=0.296, 0.183, 0.846）. But, minimum GCIPL thickness was reduced in ME eyes compared with non-ME eyes（P=0.022）. Final VA significantly correlated with the minimum GCIPL thickness in ME eyes（r=-0.482, P=0.007）, whereas no correlation was found with average GCIPL thickness, average pR NFL thickness and mean CMT.CONCLUSION： Minimum GCIPL thickness is reduced in ME eyes compared with non-ME eyes, and correlated with the VA in non-ischemic CRVO. These results propose that inner retinal damage occurring in patients with ME secondary to non-ischemic CRVO may lead to permanent visual defect after treatment.

Different Dosages of Intravitreal Triamcinolone Acetonide Injections for Macular Edema Secondary to Central Retinal Vein Occlusion

Purpose:.To study the effect of intravitreal injections of triamcinolone acetonide (TA) for the treatment of macular edema secondary to central retinal vein occlusion.(CRVO).in a sample of Chinese patients from Shaanxi province. Methods:.The 50 eyes from 50 patients were separated into three TA treatment groups:.17 patients were given 4 mg/0.1 ml,.19 patients were given 8 mg/0.2 ml,.and 14 patients were given 16 mg/0.4 ml. Patients were followed up for 12 months. Foveal thickness, intraocular pressure (IOP), and best-corrected visual acuity (BCVA) were measured. Results:.Macular edema responded well both anatomically and functionally to the TA injections. After the initial intravitreal injection,.macular edema recurred at 2-4 months in the low-dose group.(4 mg),.at 3-5 months in the medium-dose group (8 mg), and at 6-9 months in the high-dose group (16 mg)..No significant difference in BCVA or in foveal thickness were observed between the first intravitreal injection and the re-injection. There was no increase in IOP after re-injection of 16 mg TA,.if the patient did not have an elevated IOP after the initial intravitreal injection of 4/8 mg TA. Conclusion: A low dosage of TA (4 mg) administered via intravitreal injection might be useful as an initial treatment for macular edema secondary to CRVO..A higher dosage of TA (16mg) can be used if there is no IOP elevation with the initial TA injection.

Advances of Prevention and Nursing of Deep Venous Thrombosis after Gynecological Tumor Operation

Emainly includes deep venous thrombosis(DVT)and pulmonary thromboembolism(PTE).DVT is caused by the thrombogenesis of red blood cells,platelets and fibrous protein which obstructs the venous backflow leading to inflam-matory changes in the wall of the vein.PTE is caused by the caducous blood clots of DVT that runs with the blood to the lungs.Because DVT and PTE are the venous thromboembolic disease process in two stages,the prevention of DVT and PTE is very important for preventing the rapid onset of PTE and high mortality rate of the postoperative complications.The changes of female hormones and the blood concentration and lipid metabolism disorders make venous thromboembolism more likely to occur during pregnancy.Once the pulmonary vessels were blocked,the patients’life would be threatened severely.To find a more effective way to prevent postoperative venous thrombosis in gynecology we review the prevention and treatment of deep venous thrombosis after gynecological surgery in this paper.

Radiation Retinopathy Associated with Central Retinal Vein Occlusion

Purpose: To report a case of radiation retinopathy associated with central retinal vein occlusion. Methods: The clinical features and fundus fluorescein angiography of this case were analyzed. Results: The patient had been treated with radiotherapy for her nasopharyngeal carcinoma, and presented with sudden visual loss in the left eye. The funduscopic examination and fluorescein angiography showed the features of radiation retinopathy in both eyes, and central retinal vein occlusion in the left eye. Conclusions: Radiation retinopathy can be associated with central retinal vein occlusion in the same eye, and it seems that the endothelial cell loss caused by radiation retinopathy may lead to retinal vein occlusion.

Seeing beneath the surface:Harnessing point-of-care ultrasound for internal jugular vein evaluation

Point-of-care ultrasound(POCUS)of the internal jugular vein(IJV)offers a noninvasive means of estimating right atrial pressure(RAP),especially in cases where the inferior vena cava is inaccessible or unreliable due to conditions such as liver disease or abdominal surgery.While many clinicians are familiar with visually assessing jugular venous pressure through the internal jugular vein,this method lacks sensitivity.The utilization of POCUS significantly enhances the visualization of the vein,leading to a more accurate identification.It has been demonstrated that combining IJV POCUS with physical examination enhances the specificity of RAP estimation.This review aims to provide a comprehensive summary of the various sonographic techniques available for estimating RAP from the internal jugular vein,drawing upon existing data.